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Saturday, November 24, 2007

USA Today: OEF/OIF Combat Traumatic Brain Injury Tops 20,000 Cases

In early January of this year, as the time for final editing of Moving a Nation to Care was quickly coming to a close, I was doing one last quick scan of my galley copy. Opening it to the Preface's first page, first paragraph, out jumped what was at the time a glaring typo: a sentence stating that 20,000 of returning Afghanistan and Iraq veterans had been diagnosed with traumatic brain injury.

The publicly available figure at the time was around 2,000, and you can imagine how quickly I got on the horn to my publisher to ask that we make sure to correct the error. What a difference a year makes. From USA Today:

At least 20,000 U.S. troops who were not classified as wounded during combat in Iraq and Afghanistan have been found with signs of brain injuries, according to military and veterans records compiled by USA TODAY.

The data, provided by the Army, Navy and Department of Veterans Affairs, show that about five times as many troops sustained brain trauma as the 4,471 officially listed by the Pentagon through Sept. 30. These cases also are not reflected in the Pentagon's official tally of wounded, which stands at 30,327.

In educational interest, article(s) quoted from extensively.

Continuing:

The data came from:

• Landstuhl Army Regional Medical Center in Germany, where troops evacuated from Iraq and Afghanistan for injury, illness or wounds are brought before going home. Since May 2006, more than 2,300 soldiers screened positive for brain injury, hospital spokeswoman Marie Shaw says.

• Fort Hood, Texas, home of the 4th Infantry Division, which returned from a second Iraq combat tour late last year. At least 2,700 soldiers suffered a combat brain injury, Lt. Col. Steve Stover says.

• Fort Carson, Colo., where more than 2,100 soldiers screened were found to have suffered a brain injury, according to remarks by Army Col. Heidi Terrio before a brain injury association seminar.

• Marine Corps Base Camp Pendleton, where 1,737 Marines were found to have suffered a brain injury, according to Navy Cmdr. Martin Holland, a neurosurgeon with the Naval Medical Center San Diego.

• VA hospitals, where Iraq and Afghanistan veterans have been screened for combat brain injuries since April. The VA found about 20% of 61,285 surveyed — or 11,804 veterans — with signs of brain injury, spokeswoman Alison Aikele says. VA doctors say more evaluation is necessary before a true diagnosis of brain injury can be confirmed in all these cases, Aikele says.

Soldiers and Marines whose wounds were discovered after they left Iraq are not added to the official casualty list, says Army Col. Robert Labutta, a neurologist and brain injury consultant for the Pentagon.

"We are working to do a better job of reflecting accurate data in the official casualty table," Labutta says.

Earlier in the month, USA Today's Gregg Zoroya also reported on a disturbing trend related to the mission-driven and 'buddy, I have your back' mentality -- honorable qualities, to say the least -- of our troops fighting overseas. Apparently, these positive attributes may be making the job of TBI diagnosis a bit more tricky:

Troops in Iraq and elsewhere have tried to avoid being pulled out of combat units by cheating on problem-solving tests that are used to spot traumatic brain-injury problems, military doctors say.

New versions of the tests were sent into Iraq late last month to prevent the cheating, says Air Force Lt. Col. Michael Jaffee of the Defense and Veterans Brain Injury Center in Washington, D.C.

"With highly motivated individuals, be they athletes, be they our servicemembers in harm's way, there is a motivation to stay with the unit and stay on the job or stay in the game," he says. The tests, administered by medics in the field, are the military's primary means of uncovering subtle signs of brain injuries from exposure to blasts.

Reports of cheating began surfacing in Iraq during the summer, says Col. Brian Eastridge, a trauma surgeon who supervises medical care in Iraq and Afghanistan from his office in Baghdad.

Troops had obtained copies of an older version of the test and memorized key words used to gauge short-term memory, Jaffee says. Those who fail areas of the test undergo more sophisticated exams for diagnosing brain injury. If symptoms persist, soldiers are sent home. If symptoms get better in days or a few weeks, patients can be sent back into combat, doctors say.

At the Landstuhl Regional Medical Center in Germany, cheating was found in a handful of cases about four months ago, says Army Col. Stephen Flaherty, the hospital's chief of surgery. Landstuhl is where all troops evacuated from Iraq or Afghanistan suffering from illness, injury or wounds are delivered before going home.


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